title: Midazolam versus propofol for long-term sedation in the ICU: a randomized prospective comparison.
abstract: OBJECTIVE
  To compare the efficacy, safety, and cost of midazolam and propofol in prolonged sedation of critically ill patients.
  
  
  METHODS
  Randomized, prospective study.
  
  
  METHODS
  General intensive care unit (ICU) in a 1100-bed teaching hospital.
  
  
  METHODS
  67 critically ill, mechanically ventilated patients.
  
  
  METHODS
  Patients were invasively monitored and mechanically ventilated. A loading dose [midazolam 0.11 +/- 0.02 (SEM) mg.kg-1, propofol 1.3 +/- 0.2 mg.kg-1] was administered, followed by continuous infusion, titrated to achieve a predetermined sedation score. Sedation was continued as long as clinically indicated.
  
  
  RESULTS
  Mean duration of sedation was 141 and 99 h (NS) for midazolam and propofol, respectively, at mean hourly doses of 0.070 +/- 0.003 mg.kg-1 midazolam and 1.80 +/- 0.08 mg.kg-1 propofol. Overall, 68% of propofol patients versus 31% of midazolam (p < 0.001) patients had a > 20% decrease in systolic blood pressure after the loading dose, and 26 versus 45% (p < 0.01) showed a 25% decrease in spontaneous minute volume. Propofol required more daily dose adjustments (2.1 +/- 0.1 vs 1.4 +/- 0.1, p < 0.001). Nurse-rated quality of sedation with midazolam was higher (8.2 +/- 0.1 vs 7.3 +/- 0.1 on a 10-cm visual analog scale, p < 0.001). Resumption of spontaneous respiration was equally rapid. Recovery was faster after propofol (p < 0.02), albeit with a higher degree of agitation. Amnesia was evident in all midazolam patients but in only a third of propofol patients. The cost of propofol was 4-5 times higher.
  
  
  CONCLUSIONS
  Both drugs afforded reliable, safe, and controllable long-term sedation in ICU patients and rapid weaning from mechanical ventilation. Midazolam depressed respiration, allowed better maintenance of sedation, and yielded complete amnesia at a lower cost, while propofol caused more cardiovascular depression during induction.
authors.affiliation: Departments of Anesthesiology and Critical Care Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Israel.
authors.forename: A A
authors.initials: AA
authors.lastname: Weinbroum
authors.forename: P
authors.initials: P
authors.lastname: Halpern
authors.forename: V
authors.initials: V
authors.lastname: Rudick
authors.forename: P
authors.initials: P
authors.lastname: Sorkine
authors.forename: M
authors.initials: M
authors.lastname: Freedman
authors.forename: E
authors.initials: E
authors.lastname: Geller
mesh_terms: D000328:Adult; D016638:Critical Illness; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D015742:Propofol / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome; D015300:Ventilator Weaning
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol